CONCEPT ANALYSIS: PATIENT SAFETY

Purpose: The purpose of this concept analysis was to identify the defining attributes and to present sample cases that would help distinguish the concept of patient safety from the concept of quality of care. Applicability of CALNOC indicators as empirical referents of patient safety were also explored, in preparation for future research.

Background: Since the publication of the To err is human: Building a safer health system report by the Institute of Medicine (IOM), various government and private sectors across the nation, including the Agency for Healthcare Research and Quality (AHRQ) and the Joint Commission, have been committed to ensuring basic patient safety, tracking progress, and investing in research and dissemination of information related to prevention of medical errors. In addition, alliances of health care organizations and providers such as the National Quality Forum (NQF), the National Center for Nursing Quality (NCNQ), the Hospital Quality Alliance, and the Collaborative Alliance for Nursing Outcomes (CALNOC) have endorsed lists of measurable indicators to facilitate collection, monitoring, and reporting of healthcare performance and patient outcomes. Unfortunately, these lists of indicators vary from entity to entity, making consistent collection and measurement of outcomes challenging. Furthermore, previous concept analyses found in nursing literature do not provide a clear explanation of the attributes and sample cases that would help distinguish the concept of patient safety from the concept of quality of care; hence, the two concepts are often used interchangeably.

Methods: A concept analysis on patient safety was conducted applying Walker and Avant’s (2010) conceptual analysis process: 1) selecting a concept, 2) determining the aims/purposes of analysis, 3) identifying all uses of the concept, 4) determining the defining attributes, 5) constructing a model case, 6) constructing borderline, related, contrary, and illegitimate cases, 7) identifying antecedents and consequences, and 8) defining empirical referents. A literature search was conducted through PubMed and Cumulative Index to Nursing and Allied Health Literature Plus (CINAHL Plus) using the terms “patient safety” and “concept analysis,” “attributes,” or “definition” in the title and or abstract. All English-language literature published between 2002-2014 were considered for the analysis.

Results: The primary emphasis of patient safety is the prevention of the negative aspects of care that can potentially harm patients, while the emphasis of quality care is promoting the positive aspects of care. The defining attributes most frequently associated with the concept of patient safety in the reviewed literature include: 1) prevention or reduction of errors and adverse events, 2) protection of patients from harm or injury, and 3) collaborative efforts by individual healthcare providers as well as the healthcare system. The application of CALNOC indicators as empirical referents would facilitate the measurement of identified defining attributes of patient safety.

Conclusions: The defining attributes and empirical referents identified in this analysis may help facilitate consistent measurement of patient safety across healthcare organizations. The results of this concept analysis may also be used to guide development of a conceptual model and framework that can be applied in an international context, strengthening future patient safety research.